The Nation’s Quality of Life and Standard of Living
Are at Serious Risk:  We Must Act Now

Helen Darling, President
National Business Group on Health

As a country, we have been blessed with almost unbounded natural resources, a commitment to democracy, respect for individual differences, protection of individual rights that finally included everyone, strong religious groups, and support for innovation and entrepreneurialism. Altogether, these and other critical factors have made us the most powerful country in the world and one of the wealthiest countries ever.  While our history is complex, and certainly not perfect, most of our people, including millions of immigrants, have enjoyed a better life in the U.S. than in many other countries and each generation for the most part has been healthier, enjoyed a higher quality of life and an ever-increasing standard of living.

What’s the Problem?

But all of that progress is coming to a screeching halt and the nation’s future and its future workforce, on which we are all dependent for our standard of living, are at serious risk by a relatively new enemy—obesity—that is hurting millions of people every year.  With an estimated 2007 population of over 300 million,  using the 2006 estimate of 24.4 percent obese would mean that over 73 million people in the U.S. are already obese, a staggering fact. “The effects of obesity are similar to 20 years of aging.” ^[1] Another third of the U.S. population is overweight, and many of them will move from just overweight to obese if we don’t act quickly.

While we have made progress in reducing the use of tobacco, accidents and deaths related to motor vehicles, and many other areas enumerated in this excellent report, we are falling way behind with the tragic disease and disability impact of the obesity epidemic on adults and children. As Dr. Julie Gerberding, Director of the Centers for Disease Control (CDC), said, this upcoming generation may be the first in the U.S. ever to be worse off than their parents because of very unhealthy eating and sedentary lifestyles. The obesity epidemic is causing significant increases in many serious health problems, including devastating type II diabetes, heart disease, kidney failure, cancer, depression, arthritis and joint, back and limb disorders, to name just some of the conditions best documented so far. Pediatricians are especially alarmed because they are already seeing heart disease and other “middle age male” disorders in children, teens and young adults because of very poor eating habits, including much too much food, and lack of physical activity.

Whether we care about saving children from the lifetime effects of obesity because early obesity is a tragedy for children, or we care about the adults because the health, workers’ compensation and disability costs will drive up costs in ways that will affect every other private or public expenditure, we need to act now. Whether we care about falling behind many other nations in terms of quality of life and standard of living, or we hate to see our workforce become unproductive and inferior, unable to compete in the global economy, unable to support our economy or be able to pay taxes to cover other desirable public expenditures, we need to act now. 

All of us in the public sector and the private sector have to work together to stop the epidemic of obesity and related diseases and disabilities.  We have to make dramatic changes in those things we have control over and we have to influence public policies that change our environments that work against healthy lifestyles and physical activity —including the way our towns and cities are built without sidewalks, safe paths and roads, and places to play, walk  or run.

Using America’s Health Rankings

America’s Health Rankings and the outstanding empirical work behind this report provide us with profiles for all states and can guide us—including private and public employers, policymakers, providers, payers, foundations and citizens —to identify, and celebrate the successes, then quickly jump to the most serious problems that need attention, especially those that are getting steadily worse. As summarized in last year’s report, “from 1990 to 2006, the prevalence of obesity increased 110% from 11.6 percent in 1990 to 24.4 percent in 2006. Between 2005 and 2006 alone, the prevalence grew from 23.1 percent to 24.4 percent.” Twenty four states had rates of obesity greater than 25 percent, with West Virginia, Louisiana, and Mississippi having over 30 percent of their population obese. But, in every state, obesity is a very serious problem so all should develop action plans to effect changes as soon as possible.

Employers Are Already Moving

Interestingly, not only do states have a lot of control over their health and health care financing programs, the state is almost always the largest employer in a state so it can have a tremendous influence. Since in this country most people under age 65 receive their health benefits from their employers, employers have discovered that they are directly affected by growing health problems and costs related to obesity. The national average cost of health benefits per active employee is fast approaching $9,000 in 2007, an expense that is hurting companies’ profitability. This is especially true for employers that have low margins, or must compete with producers of goods and services that operate in countries with low labor costs.  For those reasons, most private sector employers and some public employers have instituted comprehensive health improvement strategies that include encouragement, sometimes with financial incentives, for the adult employees and dependents to complete confidential, secure health risk assessments (HRAs). Some employers also offer incentives to employees and adult dependents to talk with a health professional about any identified risk factors.  Employers may also offer and even pay for participation in programs aimed at risk factor mitigation. Employers should all do more, working with their health plans and providers to reach every employee and family member with information, tools and resources, while also making the work site models for healthy living.

At the National Business Group on Health, a non-profit membership organization of mostly very large employers, including 65 of the Fortune 100, we established in 2002 an Institute on the Costs and Health Effects of Obesity, which is supported by 30 corporate employers, and strategic partners, including UnitedHealth Group.  In the third year of a program to select “Best Employers for Healthy Lifestyles,” we awarded Platinum, Gold and Silver level rewards to 41 large employers. They have not only demonstrated their commitment to promoting healthy lifestyles for their employees and dependents, but have also shown us how many different ways we can change the environments in which we work and live to make it easier for people to reduce their weight and maintain it in a healthier range, as well as increase their physical activities. The Institute has developed a wide range of tools and resources for employers to use, including cafeteria, catering and vending machine audits and best dining practices, communication guidance, newsletters, and other methods for working with employees and their families.

So What Must We Do?

Virtually all legislators and community leaders understand the relationships between the quality of education and the quality of its workforce and the impact on its ability to attract and retain good jobs. Unfortunately, very few have caught on to the enormous negative effects of high rates of obesity on the workforce’s productivity and the labor costs associated with a state or community. Those communities with less obesity and more of a culture of wellness and health promotion can promote those advantages and work to maintain them. Other communities will want to change their profile and make wellness initiatives a part of their campaigns for recruiting businesses to their area.

Employers can and should make certain that what they control in their own work environments facilitate and empower employees to choose healthy lifestyles. Just as no one would any longer serve cigarettes at a business meeting, employers should look at everything they serve or give access to with a sharp eye. Employers should also ensure that their health benefit coverage be well aligned with a comprehensive health improvement strategy that is supported at the highest level within the organization.

We must react with the same sense of urgency as we would if a devastating infectious disease epidemic was sweeping our nation.  As the work of the United Health Foundation shows us, every stakeholder group has a job to do, starting with our schools.

• First, the school systems and their leaders must conduct rigorous audits and require that schools offer only healthful food and snack choices, using good cooking and preparation techniques to make them enjoyable and kid-friendly.

• Second, schools need to return to teaching youngsters about the impact of food choices on weight and related health problems, using clever and lively communications to reach kids. 

• Third, schools have to include physical education and fitness programs.  If children do not maintain healthy weights, they will suffer and they will also make poor workers, citizens and taxpayers. The message has to be these are “not nice to do” but are essential action steps for the health and long term viability of the community.

The states, counties and municipalities need to identify every opportunity they can to build support for healthier lifestyles and more physical activity.

• All public sector initiatives should be required to include programs to support good health, including nutrition and health aides to educate every parent or adult on public assistance or in other public programs.
   
• They must also look at their own employees and family members who need help in changing their life decisions and in understanding the impact of their unhealthy choices.
   
• Federal, state and local governments should create a cadre of “healthy lifestyle assistants or health aides,” from the neighborhoods and the communities, who would be carefully selected and specially trained to teach people in their homes, faith organizations and other gathering places.

We once had a War on Hunger and a War on Poverty. War is not the right term at this time so we should find something more like a Campaign for Healthy Living so we don’t waste a whole generation of children whose early obesity will leave them at risk for life. Not only would a health or nutrition aide program lead to improved health at the community level, by reaching people who might not get help through regular channels, health aides would provide jobs and career paths for people, mostly women, in poor and low income neighborhoods.

Leading medical organizations need to make the reduction of obesity as important a mission as any they have ever had because obesity’s effects are so dire.  They of all organizations know that.  They should follow the guidance of the American Academy of Pediatrics which has urged its members to talk with children and their parents about healthy weight and to routinely measure their patients’ weights.  We should make certain that all physicians and other health professionals have easily accessible tools and resources, as well as guides for how to talk about these issues in culturally competent ways, especially when the conversation may be awkward.  

Conclusion

We are a great country, in many ways, filled with pragmatic, problem solvers.  Our innovative and entrepreneurial spirit can be used to solve even the most complex problems, if we have the political will and the right leadership. When we look historically at the health status of our nation, there has been nothing yet that has had the effect that the obesity epidemic will have on future diseases, disabilities, depression, and dependency on the public and even the health care workforce.  In 2007, over 73 million Americans were obese. If we could return to the rate of obesity in the U.S. in 1990, we would have 45 million fewer obese individuals. 

We won’t get there overnight but we have to start now to turn the country around. We made great strides with smoking and use of seat belts and child safety seats; we can do the same with obesity. United Health Foundation’s America’s Health Rankings give us the quantitative resources to get us moving, and the benchmark data to track and evaluate our progress. We should let nothing distract us.  Every child or teen that becomes obese could have a lifetime of misery, illness and dependency. We can’t let that happen. We owe them the right start in life and we need them to be healthy—not dependent. We have to do this for them and for us. 

Endnotes

[1] R Sturm, “ The Effects of Obesity, Smoking, and Drinking on Medical Problems and Costs,”  Health Affairs, March/April 2002; 21 (2): 245-25.